Boosting Your Mental Health with Expressive Writing

George felt weighed down as he checked into yet another motel room. This was his ninth business trip in one month. He didn’t used to mind the traveling so much. Sure, it gets tiring, but he was also feeling irritable, disheartened, and down. He loosened his tie and collapsed on the bed.

Lifting his head, he noticed a notepad and pen on the bedside table. He sat there and started scribbling away, writing about everything and anything – whatever came to mind with no analysis or self-censorship. He just let words flow on to the page. After about 20 mins or so, he sat back with a sense of satisfaction. He felt lighter in his body and more clear-headed in his mind.

He decided to repeat this activity the next day before his first meeting. He even spent a few minutes in the end reflecting on some of the things that were going well in his life. As he left his room to go to work, he was pleased to feel the bounce in his step return.

Whether in movement, song, dance, art, music, or words, there is something natural and liberating about self-expression. Not surprisingly, it can be a useful medium for processing challenging moments and accumulated stress. It can also promote self-empowerment and acceptance.

I often invite my clients to try journaling. They usually ask me if there is a specific way to start. As it turns out, researchers have been studying expressive writing for a while now, seeking to determine what format works best for different issues. The following are some of the results.

Unstructured Expressive Writing

The classical writing instruction as a therapeutic practice was introduced by Pennebaker and colleagues in the 1980s. It goes as follows:

1. Write “your very deepest thoughts and feelings about an extremely difficult or emotional event that has affected you and your life…” (Baum & Rude, 2013, p.37).
2. Keep the flow of writing going for 20 minutes nonstop.
3. Don’t worry about spelling or grammar.

Gratitude Writing

Researchers also found keeping a gratitude journal can have a significant positive effect on mental health. It can create a greater sense of optimism and life satisfaction (Froh, Sefick, & Emmons 2008). A simple daily or weekly gratitude journal involves taking a few minutes to bring to mind things you are currently grateful for. Items on the list can be grand or mundane: “I am grateful that my kid is healthy” and “I am grateful for my toothpaste” are both acceptable.

Then there are gratitude letters. Researchers compared the difference between psychotherapy on its own, psychotherapy with expressive writing, and psychotherapy with gratitude letters. They discovered the option involving gratitude had the greatest beneficial impact. Here’s the gist of their approach (Wong, Owen, Gabana, Brown, McInnis, Toth, & Gilman (2018)):

1. Choose a specific person to address your gratitude letter to. The purpose is not to send the letter, though you can if you want to.
2. Reflect on and write about what it is you are grateful for in this person.
3. Repeat this exercise over an extended period. You can choose the same person as your addressee or a different person.

Expressive Writing for Depression

In 2013, Baum & Rude incorporated the benefits of mindfulness and self-compassion into the classical expressive writing practice. They discovered “expressive writing plus emotional acceptance” made a better impact on alleviating mild symptoms of depression than the classical approach to expressive writing. Both kinds of expressive writing helped mild depression more than regular writing. However, expressive writing was found not to be helpful for those with severe depression symptoms.

So if your depression symptoms are on the milder side, consider the following tips (Baum & Rude, 2013):

1. Be mindful as you write, taking an observer’s stance. Witness whatever difficult emotions that come out without judging them.
2. Include a paragraph that normalizes distressed responses in the face of difficulty and stops self-blame.

Expressive Writing for PTSD

This year, researchers published findings that expressive writing could help reduce the severity of posttraumatic stress (PTSD) symptoms. Consider the following structure (Sloan & Marx, 2018):

1. Write for 30 minutes every day and commit for at least 5 days.
2. Write from the present moment looking back, as opposed to imagining the trauma as if it were happening now; write while feeling anchored in the here-and-now, present and safe.
3. Go into the details of the events as you remember them, including thoughts and emotions.
4. Be a nonjudgmental observer of the writing.
5. Revisit the same event in your subsequent writing sessions instead of moving on to other incidents.

If you find yourself getting stuck, consider asking yourself some of these questions I adopted from different somatic psychotherapy approaches – including Somatic Experiencing and EMDR – that work with trauma:

1. “What happened next?”
2. “Who was there to help you?”
3. “When did you know you were safe?”

Expressive Writing for Test Anxiety

Studies have found expressive writing helps students with high test anxiety perform better. So if you are a teacher, consider adopting the following activity for your students (Doherty & Wenderoth, 2017; Ramirez & Beilock, 2011):

1. Set aside 10 minutes for writing prior to the exam. (If time does not allow, 5 minutes can also be effective).
2. Let your students know the purpose of this writing activity.
3. Keep the writing anonymous.
4. Let it be an optional activity.
5. Instruct your students to write “as openly as possible” about their thoughts and feelings regarding the exam they are about to take.
6. When they’re done, or when time is up, instruct them to crumple the paper and throw it away.

If you are a student with test anxiety, see if your teacher will give you time to do this before the exam. You can also try it yourself. Find a quiet place near the exam room about 15 minutes before the exam. Use 10 minutes to do the expressive writing exercise and the remaining 5 to get to your exam on time and get settled.

Writing for Sleep Disturbance

In some cases, writing exercises can also help with sleep issues. Spending 5 minutes writing a simple to-do list for tomorrow can help you fall asleep faster. Conversely, writing about tasks you already completed can delay your ability to fall asleep (Scullin, Krueger, Ballard, Pruett, & Bliwise, 2018). So if you want to fall asleep quickly, you can use pre-sleep writing to clarify tomorrow’s activities and de-clutter your head.

Designing Your Own Writing Practice

If you decide to try writing your way to mental health, let yourself be curious and discover what is the best approach for you. If you already have a writing practice, great! If modifying based on the tips above, consider a combined power punch that incorporates a gratitude section into whatever writing practice you have.

If you are thinking of using expressive writing to process a traumatic incident or to manage depression, it might be helpful and even recommended that you do so with the added support of a trained mental health professional.

References:

1. Baum, E. S. & Rude, S. S. (2013). Acceptance-enhanced expressive writing prevents symptoms in participants with low initial depression. Cognitive Therapy and Research, 37(1), 35-42. doi:10.1007/s10608-012-9435-x
2. Doherty, J. H. & Wenderoth, M. P. (2017, August 11). Implementing an expressive writing intervention for test anxiety in a large college course. Journal of Microbiology & Biology Education, 18(2), 39. doi: 1128/jmbe.v18i2.1307
3. Froh, J. J., Sefick, W. J., & Emmons, R. A. (2008). Counting blessings in early adolescents: An experimental study of gratitude and subjective well-being. Journal of School Psychology, 46(2), 213-233. doi:10.1016/j.jsp.2007.03.005
4. Ramirez, G., & Beilock, S. L. (2011). Writing about testing worries boosts exam performance in the classroom. Science, 331(6014), 211-213. doi:1126/science.1199427
5. Rude, S. S. & Haner, M. L. (2018, February 13). Individual differences matter: Commentary on “Effects of expressive writing on depressive symptoms—A meta‐analysis”. Clinical Psychology: Science and Practice, 25(1), e12230. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1111/cpsp.12230
6. Scullin, M. K., Krueger, M. L., Ballard, H. K., Pruett, N., & Bliwise, D. L. (2018). The effects of bedtime writing on difficulty falling asleep: A polysomnographic study comparing to-do lists and completed activity lists. Journal of Experimental Psychology: General, 147(1), 139-146. doi:1037/xge0000374
7. Sloan, D. M. & Marx, B. P. (2018). Maximizing outcomes associated with expressive writing. Clinical Psychology: Science and Practice, 25(1), e12231. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1111/cpsp.12231
8. Wong, Y. J., Owen, J., Gabana, N. T., Brown, J. W., McInnis, S., Toth, P., & Gilman, L. (2018). Does gratitude writing improve the mental health of psychotherapy clients? Evidence from a randomized controlled trial. Psychotherapy Research: Journal of the Society for Psychotherapy Research, 28(2), 192-202. doi:10.1080/10503307.2016.1169332

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